(1) Health Insurance Coverage

Figure 1

The following figure displays the trend in the uninsured rate between 2008 and 2015. Results are shown for the USA average (in black), as well as for every individual state (in color).

We see a clear downward trend in the uninsured rate once most of the Affordable Care Act (ACA) provisions were implemented in 2014. The overall US uninsured rate decreased from 18.2% in 2010 to 10.5% in 2015.

However, note that the disparities in uninsured rates largely continue to persist among the states, with regional patterns (using Bureau of Economic Analysis (BEA) regions). States of the Southeast and Southwest consistently had the highest uninsured rates, while states of New England consistenely had the lowest insured or highest health insurance coverage rates.

Figure 2

In the following plot, I explore the difference between Democratic and Republican states, based on the 2012 US Presidential Election results. Generally, the democratic states consistently have had largely have a lower uninsured rate than the Republican states, though both groups experienced declines in the uninsured rates in 2014. The rate of decline of uninsured rates in 2014 for many Republican states appeared to exceed that of the Democratic states, mainly because of their higher starting point.

Figure 3

This plot shows insured rates in 2015 at a glance, looking at how they differ by party (2012 winner), BEA region and income level of the states.

In terms of correlations, it appears that being a Democratic state is a strong predictor of a higher insurance rate. States in New England, the Mideast and the Great Lakes perform well in insurance rates, while states in the Southwest, Rocky Mountains and Southeast perform the poorest. As expected, high-income states have the highest insurance rates as more people would be able to afford insurance. Lower and lower-middle income states have lower coverage rates, but it is infact the lower-middle income states that have the lowest insurance rates.

Figure 4

Next, we investigate the main health insurance and coverage sources, namely employer coverage, the individual marketplace, Medicaid / Childrens’ Health Insurance Program (CHIP), and Medicare for the aged. We broke down the results by party and income level, taking a simple (unweighted) average across the states in the categories. We observe that employer coverage rates increase as income level increases, especially for Democratic states. Democratic and low income states have more people on Medicaid / CHIP than Republican and low income states.

(2) Health Outcomes and Access

Figure 5

Next, we are interested to find out how health insurance rates correlates with health outcomes. In particular, we can look at the measure of mortality amenable to healthcare intervention - the number of deaths that could have been prevented by healthcare in the year 2014. We plot avoidable mortality (2014) against insurance rates (2014) and observe a negative relationship as expected. States that have higher rates of insurance also have better health in this respect. However, we also control for income levels as low income levels would be a major predictor of poor health, as confirmed in our plot. Yet, within each income level, the negative relationship remains, and it is especially pronounced among the upper-middle income countries.

Figure 6

The following maps how the states performed in various health outcomes, namely preventable mortality, access to a usual source of care, rate of age-appropriate cancer screenings in adults, and rate of age-appropriate vaccinations in adults. A green color incidates a comparatively more favorable outcome, while a red color indicates a less favorable outcome.

We note that the Northeast (New England) states perform consistently well across all health outcomes, while the Southeast states, as well as Texes, peform consistently poorly on all except for vaccination rates. The Western and Rocky Mountains states have a low avoidable mortality rate, despite having low rates of access to usual care and of cancer screening and vaccinations. In the measure of adult vaccination rates, the trend of the South faring poorer on health is reversed, as they do comparatively well in vaccinations.

(3) Affordability and Cost Outcomes

Figure 7

Similarly, we map how the states performed in various financial and cost outcomes, such as percentage of people with high OOP costs relative to household income, premium growth rates, affordability of the marketplace plans, and increases in federal spending related to the state.

We notice that states that do better in containing OOP costs tend to do worse in containing premium and marketplace plan rates as well as federal spending. These include some states like New York, New Jersey and Ohio in the Northeast and Midwest (Great Lakes). A notable exception is Massachussets, which performs well across the financial measures, possibly because of the headstart it got with “Romney-care”, which actually served as a model for Obamacare.

(4) Summary of States’ Performance

Figure 8

The following data table presents the rankings of the states on the following insurance coverage, health and affordability outcomes, providing a summary of the states’ performance:

  1. Percentage of population insured

  2. Deaths preventable by healthcare intervention (per 100,000 people)

  3. Proportion of adults with access to a usual source of care

  4. Proportion of people with high out-of-pocket costs (relative to household income)

  5. Annual rate of health insurance premium growth from 2010 to 2015

A rank of 1 always indicates the more favorable outcome (i.e. higher insurance and treatment access rate, lower preventable mortality, OOP costs and premium growth)

Figure 9